目的:探讨共焦显微镜检查在小梁切除术后干眼诊疗中的应用价值。方法:对行小梁切除术的青光眼患者42例58眼,术前1d;术后1wk;1,3mo进行活体共焦显微镜(confocalmicroscopy,CM)检查,观察角膜组织的形态学改变,结合泪膜破裂时间(breaking-up time,BUT)、基础泪液分泌试验(SchirmerⅠtest,SⅠt)分析小梁切除术后眼表结构的变化。结果:与术前相比,术后1d;1wk术眼角膜上皮细胞密度下降,大小不均,高反光细胞增多。SⅠt程度明显增加,BUT缩短,差异有统计学意义(P<0.05),术后1,3mo时CM检查显示角膜上皮细胞形态、密度、SⅠt及BUT程度恢复至术前水平,与术前比较差异无统计学意义(P>0.05)。结论:通过CM检查可在细胞水平上评价小梁切除术对眼表结构的影响,对术后早期干眼的诊断和治疗有重要的临床指导价值。

AIM:To investigate the application of confocal microscopy in the diagnosis and treatment of dry eye after trabeculectomy.METHODS:In vivo confocal microscopy(CM) examination was conducted in 42 glaucoma patients(58 eyes) 1 day before and 1 week,1 month,3 months after trabeculectomy to observe the morphology changes of corneal tissue,and combining breaking-up time(BUT),Schirmer Ⅰ test(SⅠt) to analyse ocular surface changes in the structure after trabeculectomy.RESULTS:Compared with the preoperative,postoperative 1 day,1 week corneal epithelial cell density of operated eye decreased,with disparity of the size and increased high reflective cells.SⅠt was significantly increased,BUT shortened,the difference was statistically significant(P<0.05).1 month,3 months after surgery,CM examination showed corneal epithelial cell morphology,density,SⅠt and BUT recovered to preoperative levels.Compared with the preoperative,the difference was not statistically significant(P>0.05).CONCLUSION:By confocal microscopy,trabeculectomy’s influence on ocular surface structure can be evaluated at the cellular level,which has important clinical value on the early postoperative diagnosis and treatment of dry eye.

R779.6